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Abstrak :
Latar Belakang. Depresi sering ditemukan pada pasien lupus eritematosus sistemik (LES) dan berhubungan dengan aktivitas penyakit LES. Kurangnya perhatian klinisi terhadap penapisan hingga tatalaksana depresi pada LES sangat berperan. Hospital Anxiety and Depression Scal (HADS) merupakan salah satu skala pengukuran depresi berbentuk kuesioner yang sering dan mudah digunakan serta memiliki banyak terjemahan yang tervalidasi sedangkan Mexican- Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI) merupakan sistem skoring untuk menilai aktivitas penyakit LES dengan biaya minimal namun mempunyai reliabilitas dan validitas yang baik. Rasio neutrofil-limfosit (RNL) merupakan penanda inflamasi sistemik sedangan anti-dsDNA merupakan autoantibodi spesifik pada LES yang kadarnya meningkat seiring dengan aktivitas penyakit. Saat ini di Indonesia, belum ada penelitian yang mengkorelasikan antara skor HADS-D dengan RNL, kadar anti-dsDNA dan skor Mex-SLEDAI pada LES. Tujuan. Mengetahui korelasi antara skor HADS-D dengan RNL, kadar anti-dsDNA dan skor Mex-SLEDAI pada pasien LES. Metode. Studi ini menggunakan desain potong lintang, dilakukan analisis data primer pasien LES usia 18-60 tahun. Dilakukan wawancara dan pemeriksaan fisik serta pengisian kuesioner HADS diikuti dengan pengambilan sampel darah untuk menilai kadar anti-dsDNA dan melengkapi perhitungan skor Mex-SLEDAI. Korelasi antara skor HADS-D dengan RNL, kadar anti-dsDNA, dan skor Mex-SLEDAI didapat dengan uji korelasi Spearman menggunakan SPSS. Hasil. Dilakukan analisis pada 121 subjek. Seluruh sampel adalah perempuan dengan median usia 31 (24-39) tahun. Median skor HADS-D sebesar 6 (4-7), median RNL sebesar 2,64 (1,945-3,91), median anti-dsDNA sebesar 133,5 (29,8-388,5), dan median skor Mex-SLEDAI sebesar 5 (3-10). Terdapat korelasi positif sangat lemah antara skor HADS-D dengan RNL (r 0,18 dan p 0,048). Terdapat korelasi positif lemah antara skor HADS-D dengan Mex-SLEDAI (r 0,244 dan p 0,007). Tidak terdapat korelasi antara skor HADS-D dengan anti-dsDNA. Kesimpulan. Terdapat korelasi positif antara skor HADS-D dengan RNL dan skor Mex-SLEDAI tetapi tidak ada korelasi antara skor HADS-D dengan kadar anti-dsDNA pada pasien dengan LES. ......Background. Depression is common in systemic lupus erythematosus (SLE) and can increase SLE disease activity. Lack of clinical attention to screening until the management of depression play an important role. Hospital Anxiety Depression Scale (HADS) is a depression measurement scales that is often and easy to use while Mexican-Systemic Lupus Erythematosus Disease Activity Index (Mex-SLEDAI) is a scoring system to asses disease activity at lower cost but has good reliability and validity. Neutrophil-lymphocyte ratio (NLR) is a systemic inflammation marker whereas anti-dsDNA is a specific antibody for SLE. In  Indonesia, there are no studies that correlate HADS-D score with NLR, anti-dsDNA level, and Mex-SLEDAI score in SLE patients. Objective. To determine the correlation between HADS-D score with NLR, anti-dsDNA level, and Mex-SLEDAI score in SLE patients. Methods. This study used a cross-sectional design that analysed the primary data of SLE patients aged 18-60 years. Interviews and physical examinations were carried out as well as filling out the HADS questionnaire followed by blood sampling to assess anti-dsDNA levels and calculate Mex-SLEDAI score. The correlation between HADS-D score with NLR, anti-dsDNA level, and Mex-SLEDAI score were obtained by using the Spearman correlation test using SPSS. Results. This study analysed on 121 subjects with a median age of 31 (24-39) years. The median HADS-D score was 6 (4-7), median NLR was 2.64 (1.945-3.91), median anti-dsDNA level was 133.5 (29.8-388.5), and median Mex- SLEDAI score was 5 (3-10). There is a very weak positive correlation between HADS-D and NLR (r 0.18 and p 0.048) and weak positive correlation between HADS-D and Mex-SLEDAI (r 0.244 and p 0.007). There is no correlation between HADS-D and anti-dsDNA. Conclusion. There are positive correlation between HADS-D score with NLR and Mex-SLEDAI score but there is no correlation between HADS-D score with anti-dsDNA level in SLE patients.

Abstrak :
Latar Belakang Diabetes melitus dapat menyebabkan gangguan sistem saraf otonom (SSO) yang disebut sebagai neuropati otonom diabetik. SSO mengendalikan banyak sistem organ dan salah satu gangguannya dapat bermanifestasi sebagai disfungsi ereksi (DE). Prevalensi DE dan neuropati otonom diabetik di dunia masih beragam dan hubungan keduanya masih memiliki hasil yang bervariasi. Dengan deteksi dini neuropati otonom diabetik diharapakan dapat turut mendeteksi DE dan mencegah progresifitas DE menjadi lebih berat. Terdapat pilihan skrining untuk mendeteksi neuropati otonom salah satunya dengan Survey of Autonomic Symptom (SAS) dan pemeriksaan variabilitas detak jantung (HRV) Tujuan Mengetahui proporsi dan hubungan antara neuropati otonom dengan disfungsi ereksi pada DMT2 yang dinilai dengan kuesioner SAS dan pemeriksaan HRV Metode Penelitian ini menggunakan studi potong lintang dari 86 pasien DMT2 di Poliklinik Metabolik Endokrin RSUPN dr. Cipto Mangunkusumo sejak Agustus 2021 hingga November 2021. Pasien dilakukan wawancara dengan kuesioner SAS, IIEF-5, dan Pemeriksaan HRV. Dilakukan analisis multivariat untuk menilai hubungan variabel bebas dan terikat setelah dikontrol dengan variabel-variabel perancu yang berhubungan. Hasil Pada penelitian ini didapatkan proporsi pasien DE pada DMT2 sebanyak 59,3%. Proporsi pasien neuropati otonom yang dinilai dengan HRV sebanyak 94,3% dan neuropati otonom yang dinilai dengan kuesioner SAS sebanyak 41,9%. Terdapat hubungan secara statistik bermakna setelah dilakukan analisis multivariat antara neuropati otonom diabetik yang dinilai dengan kuesioner SAS dengan DE (adjusted OR 18,1 [IK95% 3,90-84.33]). Pemeriksaan HRV dalam penelitian ini tidak menunjukan hubungan yang signifikan secara statistik dengan DE. Kesimpulan Proporsi pasien dengan neuropati otonom diabetik yang dinilai dengan kuesioner SAS didapatkan sebesar lebih dari 40% dan yang dinilai dengan HRV lebih dari 90%. Terdapat hubungan yang secara statistik bermakna antara neuropati otonom diabetik yang dinilai dengan kuesioner SAS dengan DE. ......Background Diabetes mellitus (DM) affecting the autonomic nervous system known as diabetic autonomic neuropathy (DAN), which controls many organ systems and can manifest as erectile dysfunction (ED). The range of ED and DAN prevalence has been found to vary widely depending on the baseline comorbidities in the population of the subject studied. Autonomic neuropathy is still rarely studied and its relationship with erectile dysfunction needs to be explored whether the two variables are related. By early detection of autonomic neuropathy, it is hoped that can help detect ED and prevent the progression more severe. There are screening options to see autonomic neuropathy: survey of Autonomic Symptoms (SAS) questionnaire and Heart rate variability (HRV) test. Objective To determine the proportion and relationship between diabetic autonomic neuropathy and erectile dysfunction in Type 2 DM using SAS questionnaire and HRV examination Methods Cross-sectional study of 86 type 2 DM patients at the Metabolic Endocrine Polyclinic, dr. Cipto Mangunkusumo from August 2021 to November 2021. Patients were interviewed with the IIEF-5 questionnaire, SAS and HRV examination. Multivariate analysis with logistic regression analysis was performed to assess the relationship between diabetic autonomic neuropathy with ED in the type 2 DM population. Results In this study, the proportion diabetic autonomic neuropathy in Type 2 DM was 41.9% with SAS questionnaire and 94,3% with HRV, and Proportion of ED was 59.3%. The proportion of autonomic neuropathy who had ED was 91.7% with SAS and 69,7% with HRV. There was a statistically significant relationship between diabetic autonomic neuropathy use SAS and ED (adjusted OR 18.1 [95% CI 3.90-84.33]). HRV examination did not show an association with ED in this study. Conclusion More than half of the subjects had erectile dysfunction and almost all of the patients with diabetic autonomic neuropathy had erectile dysfunction. There is a statistically significant relationship between diabetic autonomic neuropathy using SAS questionnaire and ED.

Abstrak :
Latar Belakang: Meskipun berbagai kemajuan pengobatan dicapai selama lebih dari satu dekade terakhir, secara keseluruhan prognosis karsinoma sel hati tetap buruk. Efek samping terapi serta progresifitas penyakit itu sendiri sangat mempengaruhi kualitas hidup pasien. Selain kesembuhan dan survival rate, kualitas hidup menjadi poin akhir penting dalam pengobatan kanker. Kualitas hidup pada penderita karsinoma sel hati penting untuk diteliti, karena merupakan faktor prognostik penting dari survival time, selain dapat juga mengevaluasi keuntungan dan kerugian dari modalitas terapi yang dipilih. Sampai saat ini belum ada kuesioner yang andal dan sahih untuk menilai kualitas hidup pasien karsinoma sel hati secara akurat di Indonesia. Penelitian ini bertujuan untuk mendapatkan kuesioner European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Hepatocellular Carcinoma-18 (EORTC QLQ-HCC18) yang andal dan sahih untuk digunakan di Indonesia. Metode: Penelitian ini adalah studi potong lintang. Penelitian diawali dengan menerjemahkan EORTC QLQ-HCC18 ke dalam bahasa Indonesia dan kemudian diujicobakan pada 10 responden. Setelah itu, EORTC QLQ-HCC18 hasil terjemahan digunakan pada penelitian utama dengan jumlah sampel yang lebih besar. Keandalan dinilai dengan pendekatan tes ulang dan konsistensi internal. Tes ulang dinilai dengan intraclass correlation coefficient (ICC). Konsistensi internal dinilai dengan Cronbach Alpha. Kesahihan konstruksi dinilai dengan multi-trait scaling analysis. Kesahihan kriteria dinilai dengan melihat korelasi antara domain kuesioner EORTC QLQ-HCC18 dengan Short Form 36 (SF36). Hasil: Pengambilan data dilakukan terhadap 65 pasien karsinoma sel hati yang berobat ke Poli Hepatologi maupun yang sedang dirawat di RSUPN Cipto Mangunkusumo selama Oktober 2015 ? Februari 2016. Nilai ICC (interval 1 jam) pada semua domain EORTC QLQ-HCC18 sangat baik (ICC > 0,8), kecuali domain ikterus yang termasuk dalam kategori baik (ICC 0,61-0,8). Nilai Cronbach Alpha > 0,7 pada separuh jumlah domain EORTC QLQ-HCC18 kecuali domain ikterus (0,137), nyeri (0,474), dan citra tubuh (0,599). Sedangkan nilai Cronbach Alpha yang diperoleh dari penggabungan seluruh domain tetap baik, yaitu 0,897. Multi-trait scaling analysis menunjukkan korelasi cukup tinggi antara skor butir pertanyaan dengan skor domainnya sendiri. Sedangkan hubungan butir pertanyaan dengan domain yang berbeda selalu mempunyai korelasi yang lebih rendah dibandingkan dengan domainnya sendiri. Pada uji kesahihan kriteria, didapatkan 42 korelasi (dari total 64 korelasi) dengan r ≥ 0,3 dan p < 0,05 antara domain EORTC QLQ-HCC18 dengan SF36. Simpulan: Kuesioner EORTC QLQ-HCC18 merupakan alat ukur yang andal dan sahih untuk menilai kualitas hidup pasien karsinoma sel hati di Indonesia.

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Background: Despite various therapeutic progress has been achieved over the past decade, the overall prognosis of hepatocellular carcinoma remains poor. Each therapy undertaken certainly has side effects. Adverse effect of treatment and the progression of the disease itself greatly affect the patient?s quality of life. In addition to recovery and survival rate, quality of life becomes extra important end point in cancer treatment. Quality of life in hepatocellular carcinoma is important to investigate, because quality of life has become an important prognostic factor of survival time, whilst quality of life can also evaluate the cost and benefit of chosen therapeutic modalities. Currently there is no specific questionnaire that can assess the quality of life of hepatocellular carcinoma patients accurately in Indonesia. This study aims to get a reliable and valid EORTC QLQ-HCC18 questionnaire to assess the quality of life of patients with hepatocellular carcinoma in Indonesia. Methods: This is a cross-sectional study. The study began by translating the EORTC QLQ-HCC18 into Indonesian and then tested on 10 respondents. After that, the Indonesian version of EORTC QLQ-HCC18 is used in the main study with a larger sample size. The questionnaire reliability was assessed with test-retest and internal consistency approach. Test-retest was assessed with intraclass correlation coeficient (ICC). Internal consistency was assessed by Cronbach alpha. Construct validity was assessed by multi-trait scaling analysis. The criteria validity assessed by looking at the correlation between domains of EORTC QLQ-HCC18 with Short Form 36 (SF36). Results: Data was collected from 65 hepatocellular carcinoma patients who came to Hepatology Polyclinic or were hospitalized at Cipto Mangunkusumo National General Hospital from October 2015 to February 2016. ICC value (1 hour interval) in all domains of EORTC QLQ-HCC18 is very good (ICC> 0.8), except icterus domain which categorized as good value (ICC 0,61-0,8). Cronbach alpha values > 0.7 obtained in almost half of domains of EORTC QLQ-HCC18, except icterus (0,137), pain (0,474), dan body image domain (0,599). Whereas the Cronbach Alpha obtained from merging the entire domains was still good (0,897). Multi-trait scaling analysis showed a fairly high correlation between the scores of the questions with a score of his own domain. While the relationship of the questions with different domains always have a lower correlation than the domain itself. In criteria validity test, obtained 33 correlations with r ≥ 0,4 and p < 0,05 between domains of EORTC QLQ-HCC18 with SF36. Conclusion: EORTC QLQ-HCC18 is a reliable and valid instrument for assessing quality of life of hepatocellular carcinoma patients in Indonesia.

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Abstrak :
Latar Belakang. Populasi penderita DM tipe 2 semakin meningkat, seringkali disertai dengan komorbid, salah satunya depresi dengan prevalensi bervariasi. Depresi dapat mempengaruhi keluaran penyakit DM tipe 2. Beberapa obat antidepresan diketahui dapat mengganggu kontrol gula darah. Vitamin D, telah lama diketahui berkaitan dengan berbagai penyakit kronik, berpotensi memperbaiki gejala depresi, walaupun belum diketahui hubungannya. Tujuan. Mengetahui adanya hubungan antara kadar vitamin D pada pasien DM tipe dengan kejadian depresi pada pasien dengan DM tipe 2. Metode. Penelitian ini merupakan studi dengan desain potong lintang, dilakukan di Rumah Sakit Cipto Mangunkusumo (RSCM). Pasien DM tipe 2 yang memenuhi kriteria inklusi pada, dilakukan penapisan depresi menggunakan kuesioner BDI-II, kemudian dibagi menjadi dua kelompok, depresi (BDI-II ≥14) dan tanpa depresi (BDI-II <14). Kemudian kedua kelompok dilakukan pemeriksaan kadar vitamin D, dan dilakukan analisis perbedaan rerata pada kedua kelompok tersebut. Kemudian dilakukan analisis multivariat regresi logistik terhadap variabel perancu. Hasil. Dari 60 subjek dengan DM tipe 2 yang yang memenuhi kriteria, didapatkan 23 subjek (38,3%) yang depresi, dan 37 subjek (61,7%) yang tidak depresi. Didapatkan median kadar vitamin D 21,8 ng/mL (RIK 14,9-26,6) pada kelompok depresi, sementara median kadar vitamin D 26,5 ng/mL (RIK 23,96-34,08) pada kelompok tanpa depresi. Terdapat perbedaan bermakna antara keduanya (p = 0,001). Setelah dilakukan analisis multivariat dengan variabel perancu jenis kelamin, paparan sinar matahari, dan IMT, didapatkan adjusted odds ratio(adjusted OR) 1,123 (IK 95%: 1,003-1,259) dengan nilai p=0,045. Kesimpulan. Kadar vitamin D yang lebih rendah meningkatkan kejadian depresi pada pasien DM tipe 2. ......Background. The population of people with type 2 diabetes is increasing, which is often accompanied by comorbid, one of them is depression. The presence of depression can affect the outcome of type 2 diabetes mellitus. Some of antidepressants are known to interfere with blood sugar control. Vitamin D levels have long been known to be associated with a variety of chronic diseases, have the potential to improve symptoms of depression, although the relationship is not yet known. Methods. This research is a cross sectional study conducted at Cipto Mangunkusumo Hospital. Patients with type 2 DM who met the inclusion criteria on an outpatient basis were screened for depression using BDI-II questionnaire, then divided into two groups, depressed (BDI-II ≥ 14), and without depression (BDI-II <14). Then both groups were examined for vitamin D levels using the ELISA method, and an analysis of the mean difference between the two groups was performed. Results. From the 60 subjects with type 2 DM who met the criteria, 23 subjects (38.3%) were depressed, and 37 subjects (61.7%) were not depressed. The median of vitamin D level was 21.8 ng/mL (IQR 14.9-26.6) in the depressed group, while the median vitamin D level was 26.5 ng/mL (IQR 23.96-34.08) in the non-depressed group (p = 0.001). After doing multivariate analysis with confounding variables the adjusted odds ratio was 1.123 (95% CI: 1.003-1.259) with p value=0.045. Conclusion. Lower levels of vitamin D increase the incidence of depression in type 2 DM patients.

Abstrak :
Latar Belakang. Perawatan pasien geriatri di ruang rawat inap dapat menimbulkan dampak negatif terhadap kualitas hidup pelaku rawat pasien geriatri. Kualitas hidup pelaku rawat yang buruk dapat menyebabkan penurunan kualitas perawatan yang diberikan. Karena itu, penilaian kualitas hidup pelaku rawat pasien geriatri diperlukan. Mengetahui kualitas hidup pelaku rawat pasien geriatri yang dirawat inap di rumah sakit dan mengetahui faktor-faktor yang berhubungan dengan kualitas hidup pelaku rawat pasien geriatri yang dirawat inap di rumah sakit. Studi ini menggunakan desain potong lintang untuk meneliti faktor-faktor yang berhubungan dengan kualitas hidup pelaku rawat pasien geriatri yang dirawat inap di Rumah Sakit Cipto Mangukusumo pada bulan Agustus hingga September 2018. Studi ini menggunakan kuesioner SF-36 untuk menilai kualitas hidup pelaku rawat dengan dua luaran yaitu skor komponen fisik dan komponen mental. Analisis bivariat menggunakan uji Chi Square dan analisis multivariat menggunakan regresi logistik. Hasil. Nilai rerata komponen fisik dari pelaku rawat pasien geriatri di RSCM adalah 49,07. Sedangkan nilai rerata komponen mental adalah 51,62. Kedua nilai ini sama dengan rerata populasi (nilai 50 dengan standar deviasi 10). Berdasarkan analisis multivariat, terdapat dua variabel yang berhubungan dengan penurunan kualitas hidup komponen mental di bawah rerata populasi, yaitu jenis kelamin wanita (POR: 3,66, IK 95%: 1,39-9,59, p: 0,008), dan lama perawatan lebih dari 8 jam (POR: 3,5, IK 95%: 1,39-8,86, p: 0,008). Selain itu, terdapat dua faktor yang berhubungan dengan penurunan kualitas hidup komponen mental dibawah rerata populasi, yaitu jenis kelamin wanita (POR: 2,66, IK 95%: 1,03-6,88, p: 0,044), dan hubungan keluarga dengan pasien (POR: 7,91, IK 95%: 1,68-37,29, p: 0,009). Nilai skor kualitas hidup komponen fisik adalah 49,07, dan komponen mental 51,62. Kualitas hidup pelaku rawat pasien geriatri di rumah sakit, baik komponen fisik dan mental, sama dengan rerata populasi. Jenis kelamin wanita, dan lama perawatan lebih dari 8 jam berhubungan dengan nilai komponen fisik dibawah rerata populasi. Sedangkan jenis kelamin pelaku rawat wanita, dan hubungan keluarga dengan pasien berhubungan dengan nilai komponen mental dibawah rerata populasi.

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The high intensity of geriatric patient hospitalization has bad impact to caregiver's quality of life. Caregivers who have bad quality of life also has detrimental effect to the patient under their care. Therefor, the assessment of caregiver's quality of life is needed to make sure the optimal care for geriatric patients. To identify the quality of life in geriatric patients' caregiver and its contributing factors. This study is a cross-sectional study to identify the quality of life in geriatric patients' caregivers and its contributing factors. This study is conducted in Cipto Mangunkusumo Hospital from August to September 2018. This study utilizes SF-36 questionnaire with two major outcome, physical component and mental component. Bivariate analysis is performed by using Chi Square analysis and multivariate analysis is performed by using logistic regression. Result. The average score of physical score among geriatric patient's caregivers in Cipto Mangunkusumo hospital is 49,07. The mental score is 51,62. Both of these score are similar to the average score of populaton. There are two variables with significant association with low physical component below the population average, which include the gender of caregiver (POR: 3,66, 95% IK: 1,39-9,59, p: 0,008), and duration of caregiving more than 8 hours (POR: 3,50, 95% IK: 1,39-8,86, p: 0,008). There are also two factors that significantly associated with low mental component, which include the gender of caregiver (POR: 2,66, 95% IK: 1,03-6,88, p: 0,044), and family relationship to the patient (POR: 7,90, 95% IK: 1,68-37,29, p: 0,009). The quality of life of geriatric patient's caregiver is similar to the average score of the population. Female and the duration of caregiving more than 8 hours/day are related to low score of physical component. Female and family relation to the patient is related to low score of mental component.

Abstrak :
ABSTRAK Latar Belakang: Di Indonesia diperkirakan ada 100 pasien kanker baru per 100.000 penduduk setiap tahun dan nyeri menjadi salah satu masalah utama yang dihadapi pasien dengan kanker. Paint Management Index (PMI) adalah suatu instrumen untuk menilai tingkat kesesuaian terapi nyeri kanker yang dibuat berdasarkan panduan terapi nyeri kanker WHO dan Agency for Health Care Policy and Research (AHCPR). Kesesuaian terapi nyeri dinyatakan baik bila pemberian obat analgesik sesuai dengan kualitas nyeri yang dikeluhkan pasien. Tujuan: Mengetahui hubungan antara tingkat pendidikan dan latar belakang dokter PPDS dengan tingkat kesesuaian terapi nyeri pada pasien kanker berdasarkan PMI. Metode: Penelitian ini menggunakan desain potong lintang. Populasi penelitian adalah pasien kanker yang berobat rawat jalan maupun rawat inap di RSCM. Sampel diambil dengan metode consecutive. Data penelitian didapatkan melalui wawancara Subjek penelitian. Data dianalisis menggunakan uji chi-square dan nilai p yang dianggap bermakna apabila kurang dari 0,05. Hasil: Sampel sebanyak 98 pasien kanker dengan rerata usia 47,2 ± 13,4 tahun dan jenis kelamin terbanyak adalah perempuan (52%). Lokasi kanker tertinggi pada daerah genital (23,5%) dengan stadium kanker terbanyak pada stadium 3 (38,7%). Median intensitas nyeri sebelum dan sesudah terapi ada pada skala nyeri 4 (1-9) dan 1 (0-6). Latar belakang pendidikan dokter berasal dari 5 departemen dengan tahun pendidikan terbanyak pada tahun ketiga (54,1%). Proporsi kesesuaian terapi Antinyeri (Skor PMI ≥ 0) sebesar 54,1%. Hubungan antara kesesuaian terapi nyeri dengan latar belakang pendidikan dokter PPDS (p<0,001) dan tahun pendidikan (p=0,022). Simpulan: Proporsi kesesuaian terapi nyeri pada pasien kanker di RSCM sebesar 54,1% dan terdapat hubungan antara tingkat pendidikan dan latar belakang pendidikan dokter PPDS dalam kesesuaian terapi nyeri kanker.

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ABSTRACT Background: In Indonesia, there are an estimated 100 new cancer patients per 100.000 populations every year and pain becomes one of the major problems faced by patients with cancer. Paint Management Index (PMI) is an instrument to assess the suitability of cancer pain therapy which is based on the WHO cancer pain treatment guidelines and Agency for Health Care Policy and Research (AHCPR). Suitability of pain therapy is considered good when giving analgesics according to the pain quality which complained by the patient. Aim: To know the relationship between level of education and background of doctors who participate in specialist medical education program with the suitability of pain therapy in cancer patients based on PMI. Method: This study used a cross-sectional design. The study population was outpatients or inpatients with cancer at the RSCM. Samples were taken with consecutive sampling. Data were obtained through interview with the subjects. Data were analyzed using chisquare test and p values were considered significant if lower than 0.05. Result: There were 98 cancer patients with a mean age of 47.2 ± 13.4 years and most were female (52%). Highest location of cancers was in the genital area (23.5%) and cancer stage mostly in stage 3 (38.7%). Median of pain intensity before and after the therapy were 4 (1-9) and 1 (0-6) respectively. Doctors? educational background came from 5 different departments with the highest level of education was in the third year (54.1%). Suitability of anti-pain therapy (PMI Score ≥ 0) was 54.1%. The relationship between the suitability of pain therapy by doctors who participate in specialist medical education program (p <0.001) and level of education (p = 0.022). Conclusion: Suitability of anti-pain therapy in cancer patients in RSCM was 54,1% and there was association between the suitability of pain therapy by doctors who participate in specialist medical education program and level of education.

Abstrak :
Latar Belakang : Palliative prognostic index (PPI) adalah skor prognostik yang umum digunakan di unit perawatan paliatif. PPI mencakup lima variabel klinis yang didasari oleh penelitian Morita dkk pada tahun 1999, untuk menilai kesintasan kurang dari 3 minggu, 3 - 6 minggu atau lebih dari 6 minggu. Penelitian ini bertujuan untuk melakukan validasi skor PPI pada pasien kanker stadium lanjut yang dikonsulkan ke tim paliatif di RSCM. Tujuan : Menilai performa model skor PPI dalam memprediksi kesintasan pasien stadium lanjut di RSCM. Metode : Penelitian ini merupakan studi kohort retrospektif yang dilakukan di rumah sakit tersier terhadap pasien kanker stadium lanjut yang dikonsulkan ke tim paliatif pada Juli 2017 sampai Desember 2018S. Performa kalibrasi skor PPI dinilai dengan uji Hosmer-Lemeshow dan plot kalibrasi. Untuk menilai akurasi prediktif skor PPI, sensitivitas, spesifisitas, PPV, NPV dan akurasi setiap grup skor PPI dihitung. Diskriminasi dinilai dengan area under the reciever operating characteristic curve (AUC). Hasil Penelitian : Sebanyak 160 pasien dengan rentang usia 20–83 tahun masuk dalam penelitian ini. Performa kalibrasi skor PPI berdasarkan uji Hosmer menunjukan nilai P=0,259. Akurasi skor PPI dalam memprediksi kesintasan pasien kanker stadium lanjut penelitian untuk kesintasan < 3 minggu 81% , dengan sensitivitas 85%, spesifisitas 70%, PPV 86%, dan NPV 67%. Akurasi untuk prediksi kesintasan 3-6 minggu 76%, sensitivitas 66%, spesifisitas 88%, PPV 85% dan NPV 70%. Performa diskriminasi skor PPI ditunjukkan dengan nilai AUC sebesar 0,822 (IK95% 0,749-0,895). Simpulan : Skor Palliative Prognostic Index memiliki performa akurasi dan diskriminasi yang baik dalam memprediksi kesintasan pasien kanker stadium lanjut dalam perawatan paliatif di RSCM. ......Background : Palliative prognostic index (PPI) is a prognostic score that is commonly used in palliative care units. PPI includes five clinical variables based on the study of Morita et al in 1999, to assess survival in less than 3 weeks, 3-6 weeks or more than 6 weeks. This study aims to validate PPI scores in advanced cancer patients who are consulted to the palliative team at our hospital. Objective : To assess the performance of the PPI score model in predicting survival in advanced cancerpatients at Cipto Mangunkusumo General Hospital. Methods : This research is a retrospective cohort study conducted in a tertiary hospital of advanced cancer patients who were consulted to the palliative team from July 2017 to December 2018S. PPI score calibration performance was assessed with the Hosmer-Lemeshow test and calibration plot. To assess the predictive accuracy of PPI scores, sensitivity, specificity, PPV, NPV and accuracy of each PPI score group are calculated. Discrimination is assessed with area under the reciever operating characteristic curve (AUC). Results : Total of 160 patients with an age range of 20-83 years participated in this study. PPI score calibration performance based on the Hosmer Lemeshow test in patients with advanced cancer showed a P value of 0.259. The accuracy of PPI scores in predicting survival in advanced cancer patients in studies for survival <3 weeks 81%, with a sensitivity of 85%, specificity 70%, PPV 86%, and NPV 67%. Accuracy for prediction of survival 3-6 weeks 76%, sensitivity 66%, specificity 88%, PPV 85% and NPV 70%. PPI score discrimination performance is shown with AUC value of 0.822 (IK95% 0.749-0.895). Conclusion : Palliative Prognostic Index scores have good accuracy and discrimination in predicting the survival of advanced cancer patients in palliative care at RSCM.

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[ABSTRAK
Latar Belakang: Pasien DM dengan ulkus kaki lebih banyak yang mengalamidepresi dan memiliki kualitas hidup yang buruk. Dalam tatalaksana ulkus kaki diabetic perlu diperhatikan faktor psikososial karena diperkirakan dapat mempengaruhi penyembuhan luka melalui induksi gangguan keseimbangan neuroendokrin-imun. Beberapa penelitian mengenai pengaruh depresi pada proses penyembuhan ulkus diabetik telah dilakukan dengan hasil yang masih kontroversial.

Tujuan: Mengetahui pengaruh depresi terhadap proses perbaikan infeksi ulkus kaki diabetik, serta tingkat depresi pada pasien ulkus kaki diabetik rawat inap.

Metode: Observasional, kohort prospektif, terhadap 95 pasien ulkus kaki diabetic terinfeksi yang dirawat di RSCM dan RS jejaring dalam kurun waktu penelitian, terbagi 2 kelompok yaitu kelompok depresi dan kelompok tidak depresi. Data klinis, penilaian depresi, dan data laboratorium diambil saat pasien masuk rumah sakit kemudian dinilai perbaikan infeksi ulkus kaki diabetik dalam 21 hari masa perawatan. Dilakukan analisis bivariat dengan uji Chi-square berdasarkan batas kemaknaan (α) sebesar 5% dan analisis multivariat.

Hasil: Dari 95 subyek penelitian, 38 orang (40%) masuk dalam kelompok tidak depresi, sedangkan kelompok depresi terdiri atas 57 orang (60%). Subyek perempuan jumlahnya dominan pada kelompok depresi (70%). Komorbid terbanyak adalah hipertensi, dengan angka komorbiditas dan penyakit kardivaskular lebih tinggi pada kelompok depresi. Malnutrisi dan obesitas juga lebih banyak pada kelompok depresi (64,9% dan 31,6%), demikian pula dengan kontrol glikemik yang buruk (73,7%). Sebagian besar pasien (73,7%) yang masuk dalam kelompok depresi memiliki depresi ringan. Pada kelompok depresi 40,4% mengalami perbaikan infeksi dalam 21 hari masa perawatan, sedangkan pada kelompok tidak depresi 68,4%.

Simpulan: Depresi cenderung meningkatkan risiko atau kemungkinan tidak terjadinya perbaikan infeksi ulkus kaki diabetik, walaupun setelah dilakukan penyesuaian terhadap variabel perancu, hasil tersebut tidak bermakna secara statistik (adjusted OR 2,429 dengan IK 95% 0,890-6,632). Lebih banyak subjek dengan depresi sedang yang tidak mengalami perbaikan infeksi ulkus kaki diabetik dibandingkan dengan subjek dengan depresi ringan (93,3% dan 47,6%).

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ABSTRACT
Background: Patients with diabetic foot ulcers are more depressed and have a poor quality of life. In the management of diabetic foot ulcers, psychosocial factors need to be considered because it can influence wound healing through induction of neuroendocrine-immune balance disorders. Several studies on the effect of depression in diabetic ulcer healing process has been carried out with results that are still controversial.

Objective: To investigate the effect of depression on diabetic foot ulcer infection healing process, as well as the level of depression in patients with diabetic foot ulcers.

Methods: Observational, prospective cohort, of the 95 patients with infected diabetic foot ulcers treated at Cipto Mangunkusumo hospital and networking hospitals within the study, divided into 2 groups: group of depressed and non-depressed group. Clinical data, assessment of depression, and laboratory data were taken on admission to hospital then we assessed improvements infection of diabetic foot ulcers in 21 days of treatment. Bivariate analysis performed using Chi-square test based on the limit of significance (α) of 5%, also does multivariate analysis.

Results: Of the 95 subjects, 40%was not depressed, while the depressed group consisted of 60%. Female subjects was dominant in the depressed group (66,7%). Most comorbid was hypertension, with a number of comorbidities and disease cardivascular higher in depressed group. Malnutrition and obesity are also higher in the depression group (64,9% and 31,6%), as well as poor glycemic control (73,7%). Most patients (73,7%) included in the depressed group had mild depression. In the depressed group, 40,4% experienced improvement in 21-day period of treatment, whereas in the non-depressed group 68,4%.

Conclusion: Depression tends to increse diabetic foot ulcer infection risk to not improved, although after adjusment of confounding variables the result was not statistically significant (adjusted OR 2,429 with CI95% 0,890-6,632). More subjects with moderate depression who did not exeperience improvement when compared to subjects with mild depression did not exeperience improvement (93,3% and 47,6%). ;Background: Patients with diabetic foot ulcers are more depressed and have a poor quality of life. In the management of diabetic foot ulcers, psychosocial factors need to be considered because it can influence wound healing through induction of neuroendocrine-immune balance disorders. Several studies on the effect of depression in diabetic ulcer healing process has been carried out with results that are still controversial. Objective: To investigate the effect of depression on diabetic foot ulcer infection healing process, as well as the level of depression in patients with diabetic foot ulcers. Methods: Observational, prospective cohort, of the 95 patients with infected diabetic foot ulcers treated at Cipto Mangunkusumo hospital and networking hospitals within the study, divided into 2 groups: group of depressed and non-depressed group. Clinical data, assessment of depression, and laboratory data were taken on admission to hospital then we assessed improvements infection of diabetic foot ulcers in 21 days of treatment. Bivariate analysis performed using Chi-square test based on the limit of significance (α) of 5%, also does multivariate analysis. Results: Of the 95 subjects, 40%was not depressed, while the depressed group consisted of 60%. Female subjects was dominant in the depressed group (66,7%). Most comorbid was hypertension, with a number of comorbidities and disease cardivascular higher in depressed group. Malnutrition and obesity are also higher in the depression group (64,9% and 31,6%), as well as poor glycemic control (73,7%). Most patients (73,7%) included in the depressed group had mild depression. In the depressed group, 40,4% experienced improvement in 21-day period of treatment, whereas in the non-depressed group 68,4%. Conclusion: Depression tends to increse diabetic foot ulcer infection risk to not improved, although after adjusment of confounding variables the result was not statistically significant (adjusted OR 2,429 with CI95% 0,890-6,632). More subjects with moderate depression who did not exeperience improvement when compared to subjects with mild depression did not exeperience improvement (93,3% and 47,6%). ;Background: Patients with diabetic foot ulcers are more depressed and have a poor quality of life. In the management of diabetic foot ulcers, psychosocial factors need to be considered because it can influence wound healing through induction of neuroendocrine-immune balance disorders. Several studies on the effect of depression in diabetic ulcer healing process has been carried out with results that are still controversial. Objective: To investigate the effect of depression on diabetic foot ulcer infection healing process, as well as the level of depression in patients with diabetic foot ulcers. Methods: Observational, prospective cohort, of the 95 patients with infected diabetic foot ulcers treated at Cipto Mangunkusumo hospital and networking hospitals within the study, divided into 2 groups: group of depressed and non-depressed group. Clinical data, assessment of depression, and laboratory data were taken on admission to hospital then we assessed improvements infection of diabetic foot ulcers in 21 days of treatment. Bivariate analysis performed using Chi-square test based on the limit of significance (α) of 5%, also does multivariate analysis. Results: Of the 95 subjects, 40%was not depressed, while the depressed group consisted of 60%. Female subjects was dominant in the depressed group (66,7%). Most comorbid was hypertension, with a number of comorbidities and disease cardivascular higher in depressed group. Malnutrition and obesity are also higher in the depression group (64,9% and 31,6%), as well as poor glycemic control (73,7%). Most patients (73,7%) included in the depressed group had mild depression. In the depressed group, 40,4% experienced improvement in 21-day period of treatment, whereas in the non-depressed group 68,4%. Conclusion: Depression tends to increse diabetic foot ulcer infection risk to not improved, although after adjusment of confounding variables the result was not statistically significant (adjusted OR 2,429 with CI95% 0,890-6,632). More subjects with moderate depression who did not exeperience improvement when compared to subjects with mild depression did not exeperience improvement (93,3% and 47,6%). , Background: Patients with diabetic foot ulcers are more depressed and have a poor quality of life. In the management of diabetic foot ulcers, psychosocial factors need to be considered because it can influence wound healing through induction of neuroendocrine-immune balance disorders. Several studies on the effect of depression in diabetic ulcer healing process has been carried out with results that are still controversial. Objective: To investigate the effect of depression on diabetic foot ulcer infection healing process, as well as the level of depression in patients with diabetic foot ulcers. Methods: Observational, prospective cohort, of the 95 patients with infected diabetic foot ulcers treated at Cipto Mangunkusumo hospital and networking hospitals within the study, divided into 2 groups: group of depressed and non-depressed group. Clinical data, assessment of depression, and laboratory data were taken on admission to hospital then we assessed improvements infection of diabetic foot ulcers in 21 days of treatment. Bivariate analysis performed using Chi-square test based on the limit of significance (α) of 5%, also does multivariate analysis. Results: Of the 95 subjects, 40%was not depressed, while the depressed group consisted of 60%. Female subjects was dominant in the depressed group (66,7%). Most comorbid was hypertension, with a number of comorbidities and disease cardivascular higher in depressed group. Malnutrition and obesity are also higher in the depression group (64,9% and 31,6%), as well as poor glycemic control (73,7%). Most patients (73,7%) included in the depressed group had mild depression. In the depressed group, 40,4% experienced improvement in 21-day period of treatment, whereas in the non-depressed group 68,4%. Conclusion: Depression tends to increse diabetic foot ulcer infection risk to not improved, although after adjusment of confounding variables the result was not statistically significant (adjusted OR 2,429 with CI95% 0,890-6,632). More subjects with moderate depression who did not exeperience improvement when compared to subjects with mild depression did not exeperience improvement (93,3% and 47,6%). ]

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ABSTRAK
Latar Belakang : Morbiditas sindrom kolon iritabel SKI cukup tinggi. Kondisi stress, seperti masa studi yang panjang, banyaknya ujian, dan tugas jaga saat rotasi klinik, menyebabkan prevalensi SKI pada mahasiswa kedokteran tinggi. Perlunya diketahui prevalensi SKI pada mahasiswa kedokteran dengan menggunakan kriteria baru Roma IV dan faktor-faktor yang berhubungan Tujuan : Mengetahui prevalensi SKI pada mahasiswa kedokteran dengan menggunakan kriteria Roma IV dan faktor-faktor yang berhubunganMetode : Studi potong lintang dilakukan terhadap 350 mahasiswa kedokteran Universitas Indonesia pada bulan November-Desember 2016, pemilihan berdasarkan stratified random sampling. Kriteria diagnosis yang digunakan adalah kriteria Roma IV. Analisis bivariat dilakukan terhadap faktor-faktor yang diteliti. Analisis bivariat menggunakan uji chi square, uji T tidak berpasangan, dan alternatifnya. Analisis multivariat menggunakan regresi logistikHasil : Proporsi SKI pada mahasiswa perempuan sebesar 18,3 15,4 ndash;21,2 IK 95 dan proporsi pada mahasiswa laki-laki sebesar 9,7 7,5-11,9 IK 95 . Subtipe SKI terbanyak adalah subtipe diare 53,1 . Skor student-life stress inventory pada mahasiswa dengan SKI lebih tinggi dibandingkan tanpa SKI, untuk skor stressor 66,4 SB 11,4 vs 60,0 SB 12,2 , p=0,001 dan skor respons terhadap stressor 64,0 41-97 vs 55,0 35-88 , p

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ABSTRACT
Latar Belakang Morbiditas sindrom kolon iritabel SKI cukup tinggi. Kondisi stress, seperti masa studi yang panjang, banyaknya ujian, dan tugas jaga saat rotasi klinik, menyebabkan prevalensi SKI pada mahasiswa kedokteran tinggi. Perlunya diketahui prevalensi SKI pada mahasiswa kedokteran dengan menggunakan kriteria baru Roma IV dan faktor faktor yang berhubungan Tujuan Mengetahui prevalensi SKI pada mahasiswa kedokteran dengan menggunakan kriteria Roma IV dan faktor faktor yang berhubunganMetode Studi potong lintang dilakukan terhadap 350 mahasiswa kedokteran Universitas Indonesia pada bulan November Desember 2016, pemilihan berdasarkan stratified random sampling. Kriteria diagnosis yang digunakan adalah kriteria Roma IV. Analisis bivariat dilakukan terhadap faktor faktor yang diteliti. Analisis bivariat menggunakan uji chi square, uji T tidak berpasangan, dan alternatifnya. Analisis multivariat menggunakan regresi logistikHasil Proporsi SKI pada mahasiswa perempuan sebesar 18,3 15,4 ndash 21,2 IK 95 dan proporsi pada mahasiswa laki laki sebesar 9,7 7,5 11,9 IK 95 . Subtipe SKI terbanyak adalah subtipe diare 53,1 . Skor student life stress inventory pada mahasiswa dengan SKI lebih tinggi dibandingkan tanpa SKI, untuk skor stressor 66,4 SB 11,4 vs 60,0 SB 12,2 , p 0,001 dan skor respons terhadap stressor 64,0 41 97 vs 55,0 35 88 , p

Abstrak :
Latar Belakang: Perubahan aktivitas saraf vagal yang disebabkan oleh gangguan regulasi otonom diduga bertanggung jawab atas disfungsi sfingter esofagus bagian bawah pada Penyakit Refluks Gastroesofagus (PRGE). Namun, peran disfungsi saraf otonom (DSO) dalam patogenesis refluks laringofaring (RLF) masih belum jelas. Hubungan antara RLF dengan DSO juga diduga terkait dengan kondisi klinis lainnya, seperti gangguan cemas dan depresi, serta gangguan bernapas saat tidur (Sleep Disordered Breathing / SDB). Tujuan: Menentukan proporsi dan karakteristik DSO berdasarkan temuan Heart Rate Variability (HRV) pada pasien RLF dan kelompok kontrol. Faktor risiko lain yang dapat berkontribusi terhadap kejadian RLF dan DSO, seperti risiko terjadinya SDB dan status kecemasan-depresi, juga dinilai. Metode: Empat puluh subjek dilibatkan pada kelompok RLF dan 33 subjek pada kelompok kontrol. Laringoskopi serat optik lentur, analisis HRV, penilaian risiko SDB (Kuesioner ESS dan PSQI) serta gangguan cemas dan depresi (kuesioner HADS) dilakukan pada kedua kelompok. Hasil: Terdapat perbedaan signifikan pada proporsi disfungsi saraf otonom antara kelompok RLF dan kelompok kontrol (p=0.001), dengan proporsi disfungsi SSO pada kelompok RLF mencapai 71.4%. Perbedaan risiko SDB dan gangguan tidur berdasarkan ESS dan PSQI juga signifikan pada kelompok RLF dibandingkan kelompok kontrol (p£0,05). Status kecemasan berdasarkan HADS pada kelompok RLF juga berbeda signifikan dibandingkan kelompok kontrol (p=0,001). Kesimpulan: Proporsi disfungsi SSO pada kelompok RLF lebih tinggi daripada kelompok kontrol, dengan temuan HRV didominasi oleh penurunan SDNN dan rasio LF/HF, dan berjenis parasimpatis dominan. Risiko terjadinya SDB dan kejadian ansietas-depresi juga berhubungan dengan RLF dan DSO. ......Background: Altered vagal nerve activity caused by impaired autonomic regulation was thought to be responsible for esophageal sphincter dysfunction in Gastroesophageal Reflux Disease (GERD). Yet the role of autonomic nerve dysfunction (AND) in the pathogenesis of Laryngopharyngeal Reflux (LPR) remains unclear. LPR and AND is also thought to be associated with other entities, such as anxiety-depression and sleep-disordered breathing (SDB). Aim: To determine the proportion and characteristics of AND based on Heart Rate Variability (HRV) analysis in patients with LPR and control group. Other risk factors that might contribute to the incidence of LPR and AND, such as the risk of SDB and anxiety-depression, were also assessed. Methods: Forty subjects were enrolled in the LPR group and 33 subjects as control. Fiberoptic laryngoscopy, HRV analysis, SDB risk assessment (ESS and PSQI questionnaire), and anxiety-depression status (HADS questionnaire) were performed on both groups. Result: The difference in proportion of AND between LPR and the control group was significant (p=0.001). The proportion of AND in the LPR group was 71.4%. The difference in the risk of SDB based on ESS and PSQI was significant in the LPR group compared to control group (p≤0,05). The status of anxiety based on HADS in the LPR group was also significantly different compared to control (p=0,001). Conclusion: The proportion of AND in the LPR group was greater than control. HRV findings were characterized by reduction of SDNN and LF/HF ratio, with the domination of parasympathetic properties. The risk of SDB and the inclination towards anxiety-depression were related to LPR and AND.